Bone Mineral Density Testing in Your Office
Good for the patient - good to increase your reimbursement.
In these days of people living longer, poor diets, progesterone-estrogen imbalances, it is no wonder that the incidence of bone fractures secondary to trauma, and, the presence of osteopenia and osteoporosis is markedly on the rise. As physicians, we have the responsibility of protecting our patients against adverse events that endanger their lives and health, and, one of these is bone fracture.
My office was one of the first in Indiana to do bone mineral density testing in a private office. There were many considerations that were reviewed before we embarked upon the correct equipment. Some of the things that had to be reviewed were patient comfort measures. In our survey, most patients did not want to lie on a hard table to undergo radiographic bone density testing.
Secondarily, the room size requirement had to be addressed. I did not want to build on a room that would accommodate the hard radiology table, the x-ray equipment, and film developing equipment. We surveyed our patients and asked if they were anxious to remove their shoes to have bone mineral density testing. (Some machines require the heel to be exposed). Some require that the heel be placed in a tub of water.
Neither idea was appealing to the patient, the next thing we reviewed was the kind of report that was issued at the end of the test. Would the patient understand the numbers and their significance or could a simple graph tell them if their bone density fell into the normal, osteopenic or osteoporotic range? The answer was most machines issued reports that were so complicated a PH.D had to do the deciphering.
The next and most important consideration was the accuracy of the machine. How were the machines rated? Were they bona fide machines that could give you a true picture of the density of the bone? Were they duo photometric in their action? These were important considerations. After reading our patient wants, after reviewing the simplicity to operate the machine, we decided on a unit that has worked extremely well for us.
Before I tell you about this unit, I will tell you that this is not the only good unit on the market. I will tell you also, that I do not recommend any particular machine. I will tell you also that I receive no reimbursement from any company for mentioning the name of any machine.
The machine we selected is the Accudex duo photometry bone mineral density machine. The cost is $16,000. Before you choke to death over the price, this machine will last for years, and it is easily paid off with an average reimbursement of $50.00 per study by Medicare and Medicaid, and $130.00 from third party payors.
The machine that we picked takes up a space of 24 inches by 24 inches by 18 inches high. It requires a special printer to print an excellent report that is meaningful to the patient. It is very simple to operate. It is fully computerized and prompts the operator in the exact steps to operate the machine. There is no lying on a hard table. There is no taking off your shoes and socks. All you do is stick your middle finger into an opening on the machine, the operator follows the prompts on the instruction screen – the study is completed. The result is printed on an easy to understand graph and I have the results in my hands in 10 minutes. It is easy for the patient easy for the operator, and easy for me to get the report.
Now, bottom line: What is the advantage of this testing? It is vital in that it tells you and the patient the status of their bone density. If it is normal, continue your current diet, calcium, and Vitamin D. If the patient turns up osteopenic or osteoporotic you have learned a lot, and the patient has learned a lot, and you can embark upon treatment. I do not have to tell you that calcium with vitamin D is the starting point.
In your judgment if the patient is elderly, fragile and a good candidate for fracture, you might consider one of the bone builders-Actonel or Fosamax always on top of a diet adequate in calcium and vitamin D. You know, without my telling you, that calcium with vitamin D, 400iu must always be used with the bone boosters, or the osteopenis & osteoporoksis will worsen. We recheck the bone density in four to six months to check progress for bone density build up. If it is not going as well as we would like, we may consider Evista, if indicated, or natural progesterone cream from wild yams to correct the progesterone estrogen imbalance in the post menopausal patient.
If you can prevent only three hip fractures a year by employing bone mineral density testing, and by giving the proper treatment you have certainly helped your fellow man. Incidentally, the reimbursement is good for your income.